Substance abuse and mental disorders commonly occur together and place an incalculable burden on individuals, families, and society at large. Left untreated, co-occurring psychiatric and substance use disorders may result in troubled and unproductive lives, as this comorbidity is associated with underachievement or failure at work and school, poor health, problems fulfilling family responsibilities, abuse, violence, and legal difficulties. Co-occurring disorders frequently have a complex and bidirectional relationship and may require longitudinal, repeated assessments to establish correct diagnosis. A number of reliable instruments have been developed to improve screening and assessment in both primary care and mental health settings, but controversy persists regarding the best approach to treatment. A fundamental issue, for example, is whether to treat a mood or an anxiety disorder in the presence of ongoing alcohol or drug abuse. Although recent recommendations suggest that concurrent substance abuse should not impede treatment of psychiatric symptoms, more evidence is required to facilitate decision making during acute treatment. Further, relapse and recurrence are common among individuals with co-occurring disorders, and the issue of long-term treatment typically needs to be addressed. Optimal patient management requires a collaborative effort by mental health care professionals, addiction specialists, and primary care physicians. Therefore, it is important that physicians who care for this patient population weigh the most recent evidence on effective and integrated treatment of individuals with co-occurring mood, anxiety, and alcohol use disorders.
Although evidence from family studies suggest that genetic factors play an important role in mediating obsessive-compulsive disorder (OCD), results from genetic case-control association analyses have been inconsistent. Discrepant findings may be attributed to the lack of phenotypic resolution, and population stratification. The aim of the present study was to investigate the role that the val66met variant within the gene encoding brain-derived neurotrophic factor (BDNF) may play in mediating the development of selected OCD subtypes accounting for the aforementioned confounding factors. One hundred and twelve OCD subjects and 140 controls were selected from the South African Afrikaner population. A significant association was observed in the male subgroup, with the met66 allele implicated as the risk allele in the development of OCD. This allele was also found to be associated with an earlier age at onset of OCD in males. On the other hand, the val66val genotype was associated with more severe OCD in the female population. No evidence of population stratification was observed in Afrikaner control subjects. These preliminary results point towards genetically distinct characteristics of OCD mediated by dysfunctions in BDNF. The present investigation forms part of ongoing research to elucidate the genetic components involved in the aetiology of OCD and OCD-related characteristics.
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with major depressive disorder (MDD) and other psychiatric disorders.
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Evidence suggests that the Val66Met variant of the brain-derived neurotrophic factor (BDNF) gene may play a role in the etiology of Obsessive-Compulsive Disorder (OCD). In this study, the role of the BDNF Val66Met variant in the etiology and the phenotypic expression of OCD is investigated. Associations between the BDNF Val66Met variant and OCD, obsessive-compulsive symptom dimensions, Yale-Brown Obsessive Compulsive Scale (YBOCS) severity scores, age of onset and family history of obsessive-compulsive symptoms were assessed. The BDNF Val66Met variant was genotyped in 419 patients with sub-/clinical OCD and 650 controls. No differences in allele or genotype frequency were observed between cases and controls. In females with OCD, the Met66Met genotype was associated with later age of onset and a trend for a negative family history, whereas the Val66Val genotype was associated with a trend for lower YBOCS severity scores. Item-level factor analysis revealed six factors: 1) Contamination/cleaning; 2) Aggressive obsessions/checking; 3) Symmetry obsessions, counting, ordering and repeating; 4) Sexual/religious obsessions; 5) Hoarding and 6) Somatic obsessions/checking. A trend was found for a positive association between Factor 4 (Sexual/religious obsessions) and the BDNF Val66Val genotype. The results suggest that BDNF function may be implicated in the mediation of OCD. We found that for the BDNF Met66Met genotype may be associated with a milder phenotype in females and a possible role for the BDNF Val66Val genotype and the BDNF Val66 allele in the sexual/religious obsessions.
Read moreThe SASH study shows relatively high 12-month and lifetime prevalence rates. These findings have significant implications for planning mentalhealth services.
Read moreSAMMENDRAGTotal homocystein (tHcy) er etablert som risikofaktor for hjerte- og karsykdom. Vi har studert determinanterav plasma tHcy i et utvalg av den voksne norske befolkning basert på undersøkelse utført av Statenshelseundersøkelser i samarbeid med Universitetet i Bergen i 1992-1993. Data ble innhentet ved kliniskundersøkelse, utfylling av tre spørreskjema og ved blodtester. I alt 18 043 personer i alderen 40-67 år møttetil undersøkelse og fikk målt plasma tHcy. Plasma folat, plasma kobalamin og 677C →T mutasjonen i genetfor metylentetrahydrofolatreduktase (MTHFR) er bestemt i et underutvalg på 329 personer og på personermed svært høye tHcy verdier ( ≥ 40 μmol/L). Resultatene fra Homocysteinundersøkelsen i Hordaland harvist at kjønn, alder, folatinntak, røykevaner og kaffeforbruk er de sterkeste determinanter for plasma tHcynivå, mens kobalamininntak, fysisk aktivitet, blodtrykk og kolesterolnivå er mindre sterke determinanter.Bruk av multivitaminer eller B-vitaminer er forbundet med spesielt lave tHcy nivåer. Personer med tHcy ≥40 μmol/L er karakterisert ved høy forekomst (73%) av homozygositet for 677C →T mutasjonen i MTHFRgenet og lavt folatnivå. Vi konkluderer derfor med at livsstil og etablerte risikofaktorer for hjerte- ogkarsykdom er vesentlige for nivået av plasma tHcy i den generelle voksne norske befolkning.Nygård O, Refsum H, Ueland PM, Tverdal A, Vollset SE. Homocysteine and lifestyle. The HordalandHomocysteine Study. Nor J Epidemiol 1997; 7 (2): 221-224.ENGLISH SUMMARYTotal homocysteine (tHcy) concentration is an established cardiovascular risk factor. We have studieddeterminants of plasma tHcy among 18 043 subjects aged 40-67 years from Hordaland county in WesternNorway who participated in a health screening programme in 1992-1993. Gender, age, folate intake,smoking habits and coffee consumption are the strongest determinants of plasma tHcy level, whereascobalamin intake, physical activity, blood pressure and total cholesterol level are weaker determinants. Useof multivitamins or B-vitamin supplements are associated with particularly low tHcy levels. In patients withseverely elevated tHcy ( ≥ 40 μmol/L, n=67), the combination of homozygosity for the 677C→T mutation inthe methylenetetrahydrofolate gene and low plasma folate levels is a dominant finding whereas a minorproportion has overt cobalamin deficiency. We conclude that lifestyle and established cardiovascular riskfactors are important determinants of the plasma tHcy level in an adult Norwegian population.
Read moreThere are few population-level insights into the use of traditional healers and other forms of alternative care for the treatment of common mental disorders in sub-Saharan Africa. We examined the extent to which alternative practitioners are consulted, and predictors of traditional healer visits. A national survey was conducted with 3651 adult South Africans between 2002 and 2004, using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses for common mood, anxiety, and substance use disorders. A minority of participants with a lifetime DSM-IV diagnosis obtained treatment from Western (29%) or alternative (20%) practitioners. Traditional healers were consulted by 9% of the respondents and 11% consulted a religious or spiritual advisor. Use of traditional healers in the full sample was predicted by older age, black race, unemployment, lower education, and having an anxiety or a substance use disorder. Alternative practitioners, including traditional healers and religious advisors, appear to play a notable role in the delivery of mental health care in South Africa.
Read moreDrop-out rates during SSRI treatment in South Africa appear to be unacceptably high, whether or not patients receive concomitant benzodiazepines. Psychoeducational programs may prove valuable in increasing adherence to treatment regimes.
Read moreAn increased risk of facial clefts has been observed among mothers with lower intake of folic acid or vitamin A around conception. We hypothesized that the risk of clefts may be further moderated by genes involved in metabolizing folate or vitamin A. We included 425 case-parent triads in which the child had either cleft lip with or without cleft palate (CL/P) or cleft palate only (CPO), and no other major defects. We analyzed 108 SNPs and one insertion in 29 genes involved in folate/one-carbon metabolism and 68 SNPs from 16 genes involved in vitamin A metabolism. Using the Triad Multi-Marker (TRIMM) approach we performed SNP, gene, chromosomal region, and pathway-wide association tests of child or maternal genetic effects for both CL/P and CPO. We stratified these analyses on maternal intake of folic acid or vitamin A during the periconceptional period. As expected with this high number of statistical tests, there were many associations with P-values<0.05; although there were fewer than predicted by chance alone. The strongest association in our data (between fetal FOLH1 and CPO, P=0.0008) is not in agreement with epidemiologic evidence that folic acid reduces the risk of CL/P in these data, not CPO. Despite strong evidence for genetic causes of oral facial clefts and the protective effects of maternal vitamins, we found no convincing indication that polymorphisms in these vitamin metabolism genes play an etiologic role.
Read moreSomatization disorder is a somatoform disorder that overlaps with a number of functional somatic syndromes and has high comorbidity with major depression and anxiety disorders. Proposals have been made for revising the category of somatoform disorders, for simplifying the criteria for somatization disorder, and for emphasizing the unitary nature of the functional somatic syndromes in future classifications. A review of the cognitive-affective neuroscience of somatization disorder and related conditions suggests that overlapping psychobiological mechanisms mediate depression, anxiety, and somatization symptoms. Particular genes and environments may contribute to determining whether symptoms are predominantly depressive, anxious, or somatic, and there are perhaps also overlaps and distinctions in the distal evolutionary mechanisms that produce these symptoms.
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